COVID-19: Licensing
Q & A: CDPH Waiver of Requirements

I see that the California Department of Public Health (CDPH) issued All Facilities Letter (AFL) 20-26, which notifies hospitals of a temporary waiver of licensing requirements from March 20 through June 30, 2020. Exactly which “licensing requirements” are waived? 

All of the requirements in Title 22 and in Health and Safety Code sections 1250-1339.59 are waived, except for the requirement to report adverse events and unusual occurrences (including any substantial staffing/supply shortages that jeopardize patient care or disrupt operations). In addition, hospitals must follow their disaster response plan and infection control guidelines from the Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) related to COVID-19. 

Hospitals are not required to submit a program flex request to CDPH. However, for capacity tracking purposes during COVID-19, hospitals seeking initial licensure or to change beds or services to their license must submit an application online at the CDPH Health Care Facilities Online Application web page. The hospital does not need approval before starting to provide care. CDPH will reach out to provide technical assistance to ensure patient safety.

Some of the waived requirements include:

  • Nurse staffing ratios
  • Homeless discharge planning law
  • Requirement to report privacy breaches to CDPH
  • Working with CDPH to make changes to bed capacity or bed types
  • Required space (square foot requirements) for specific units, such as ICUs
  • Notification requirements if you downgrade/eliminate/relocate services
  • Requirement to give handouts: Patients’ Rights, observation, Sudden Infant Death Syndrome, brain death
  • Requirement to post signage in observation units
  • Quarterly reporting of health-care-associated MRSA bloodstream, clostridium difficile, and Vancomycin-resistant enterococcal bloodstream infections
  • Requirements regarding family caregivers
  • RN orientation to unit and demonstrated competency
  • Administrative penalties
  • Medical staff and credentialing

What is not waived by this All Facilities Letter?

  • Federal laws (although many federal agencies have also issued waivers)
  • State requirements to report infectious diseases, including COVID-19 positive test results, to the local public health officer and to the hospital’s CDPH district office. However, hospitals that complete the CHA  COVID-19 Tracking Tool do not need to report COVID-positive patients to their CDPH district office.
  • Cal/OSHA requirements
  • Wage and hour laws
  • Requirements about involuntary mental health patients
  • Other state laws not under CDPH’s jurisdiction (although other state agencies have also issued waivers)
  • Local ordinances, including the Los Angeles ordinance about discharging patients across state lines